Provider Demographics
NPI:1093718199
Name:CLEVELAND PHYSICAL THERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:CLEVELAND PHYSICAL THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT, MS, PT
Authorized Official - Phone:704-471-0001
Mailing Address - Street 1:1129 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4843
Mailing Address - Country:US
Mailing Address - Phone:704-471-0001
Mailing Address - Fax:704-471-0004
Practice Address - Street 1:1129 E MARION ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4843
Practice Address - Country:US
Practice Address - Phone:704-471-0001
Practice Address - Fax:704-471-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211359Medicaid
NC7301634Medicaid
NC7211362Medicaid
NC7211364Medicaid
NC7211706Medicaid
NC7210246Medicaid
NCNC1056OtherSUBMITTER ID
NC7211360Medicaid
NC7211362Medicaid